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Azita Alipour, PharmD, BCPP, BCGP (left)
Assistant Professor – Department of Pharmacy Practice
College of Pharmacy
Marshall B. Ketchum University

Shannon Eaves, PharmD, BCPS, BCPP (right)
Clinical Pharmacy Specialist – Psychiatry
Eskenazi Health, Indianapolis, IN

Transitions of care has entered the forefront of medical management due to increased recognition of the need for appropriate communication between the numerous healthcare settings. The Joint Commission has identified transitions of care as a key area and one of its leading initiatives. It has categorized the main root causes in ineffective transitions of care being breakdowns in communication, patient education, and accountability.

Pharmacy students in an acute care inpatient psychiatric setting can help prevent these breakdowns and improve patient outcomes. Initially during admission, the student can gain valuable experience dealing with the challenge of obtaining medication histories from acutely mentally ill patients, attaining records from outpatient pharmacies and providers for validation of the patient’s home medication list, and helping to create their individual medication education plan. These experiences create opportunities for the student to make significant interventions for the patient and avoid possible medication errors.

In addition, in preparation for transition from inpatient to outpatient the student can help resolve any medication coverage/cost barriers for the patient to be able to obtain their medications on discharge. Pharmacy students can resolve potential concerns by reviewing the patient’s insurance coverage while inpatient and when a need is identified (i.e., high cost medication), calling the patient’s insurance company for clarification about outpatient coverage, any prior authorization needed, and copays. Working with the case manager/social worker, students can provide the necessary information to the psychiatrist (i.e., patient’s insurance prior authorization contact information and insurance identification number) to help with obtaining medication approval prior to discharge. The pharmacy student can look into resources for patients with no insurance such as printing coupons from websites. If the patient is unable to afford any of their medications, students can review any cost-effective alternatives to recommend to the treatment team.

Pharmacy students can continue playing an integral role in this process when building upon this continuity of care during the transitioning of patients to mental health outpatient clinics. Enhanced communication within health systems is a straightforward way to improve system breakdowns and patient care breakdowns. Pharmacy students can review discharge summaries and medication lists to aid in conveying vital information from the patient’s inpatient hospitalization. Students can then organize the new medication adjustments and continued medications to involve the patient in a comprehensive discussion during their initial outpatient pharmacy appointment. This intake appointment allows the patient to receive individualized care from the student and pharmacist which can present opportunities to have more in-depth conversations regarding disease states and lifestyle modifications with the patient and expose students to this important part of outpatient care. Additionally, improving transitions of care between other hospitals, outpatient clinics, and Department of Corrections is another aspect where pharmacy students have a significant impact in patient care.  Students can further develop communication skills with other healthcare providers through collection and verification of medical information and discussion of interventions to correct any medication-related discrepancies. Furthermore, the identification of these breakdowns can create opportunities for pharmacy students to lead staff education and patient education activities.

Incorporation of pharmacy students in transitions of care is critical in optimizing patient care and teaching the next generation of pharmacists the importance of continuity of care. While inpatient, pharmacy students can be vital members of the healthcare team for medication reconciliation, patient education, and help in resolving barriers for patients to be able to continue medications upon discharge. In the outpatient setting, pharmacy students then get the opportunity to apply this skill set into comprehensive medication therapy management.

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